Information central for parenting with breast cancer.
Routine Office Visit
I remember exactly when the word “routine” lost meaning for me. It happened during a routine physical exam, just after 11 am on Tuesday, April 25, 2006, when my gynecologist found a tumor in my breast.
That morning, the nurse who guided me through two successful pregnancies greeted me warmly in the waiting room. She weighed me and, chart in hand, led me into the doctor’s office. I sat in a chair next to the desk and marveled at a virtually unobstructed view of Lake Michigan. It was a sunny day, and the lake sparkled. I noted the time on his computer screen. I was anxious to get to a meeting.
Every year, I wondered how my doctor managed to spend so much time talking with his patients before doing a physical exam. I was always so impatient, eager to get to work. Maybe other women had more to talk about - fertility, fibroids, menopause. I was just there for the Pap smear.
The doctor came in, commented on the beautiful day, and inquired about my kids. As he flipped through the chart, he asked, “Any changes over the past year?”
“Nothing new,” I said. “Besides needing to lose some weight, my health is great.”
He asked if I had any questions about birth control. No questions. He asked about any problems with my periods. No problems. He asked whether my husband and I were still flirting with the idea of having another child. No, the only thing I was flirting with was the door. Then he mentioned that I would need a mammogram next year because I was turning forty. Okay, I thought, now let’s get to the Pap smear so I can get out of here.
During the exam, I chatted mindlessly with the doctor, while looking at a Monet poster taped to the ceiling above the exam table. Then, he casually slipped into the conversation, “I’m going to have to send you for a mammogram and an ultrasound.” He had found a lump in my right breast, about three inches below my clavicle. I didn’t realize that breast tissue extended that high up. I also couldn’t believe that I hadn’t noticed the lump. It was about 2 centimeters in diameter and hard like a rubber ball.
I wasn’t worried at the time. The doctor said that he could tell it was probably nothing because of the way the lump felt to him. He finished my exam and told me to schedule a mammogram and an ultrasound with the nurse on my way out. I had an odd sensation that I should be freaking out but wasn’t. “By the way,” my doctor said, “I’ll be out of town for a few days. If you have any questions, the other doctors in the practice will be happy to help you.”
I scheduled the appointments, hurried out the door, and went to my meeting. I waited until that evening to tell Alan about the lump. I told him not to worry because my doctor could tell it was nothing. Alan looked concerned and asked if I wanted him to join me at the appointment. I said, “No, the doctor says it’s really nothing to worry about.”
Two days later, I went to the hospital for my mammogram. I changed into a gown and placed my jacket and clothing in a locker. The only thing that concerned me as I waited for my turn was the quality of the reading material. The selection was limited to issues of MAMM, a magazine about women and cancer. There was also a stack of booklets about what to do when you’re diagnosed with breast cancer. Don’t need that, I thought.
It wasn’t long before I was ushered into the mammography room. I noticed the posters on the wall saying that, while squeezing the breasts during a mammogram might be quite painful, the tests only lasts for moments. That didn’t sound good, but it turned out that the test was only mildly uncomfortable.
The technician took some pictures and then brought the slides out to the radiologist for reading. I sat in the mammography room with nothing to do but flip through more issues of MAMM. Soon the tech came in again and said that she needed to take a few more images. I asked if there was a problem, and she said, “No, this is routine.”
Soon afterwards, I was taken into the ultrasound room. It reminded me of the ultrasound tests I had when I was pregnant. I was calm because I had such happy associations with seeing the little heartbeat and later the tiny growing baby inside me. I watched as the tech squeezed some of the cold gel onto my breast and began raking it slowly with the wand. She quickly found the lump. I asked what it was, and she said, “Well, it’s not a cyst because it looks solid.” That’s when my heart skipped a beat, and I began to worry. She finished a careful exam of my right breast. Then she squeezed some gel onto my left breast. “Is something wrong with that breast?”
“The radiologist saw some spots there too,” she said calmly. I could tell that she had a lot of experience talking to anxious women about their breasts. “After we finish, the radiologist will meet with you and go over everything,” she assured me.
When the tech completed the ultrasound, she wiped the gel off me and suggested that I take a seat in a chair and wait for the radiologist to speak with me. I was left alone with my thoughts in the darkened room. An eternal optimist, I still believed the lump with just a lump. I was too young for breast cancer, and my family had little history of it.
The doctor, a petite woman who had a serious but kind look about her, came in and asked me to get back on the exam table. She used the ultrasound machine to show me the lump. She repeated what the tech said and suggested that I have a biopsy. I said, “Do you think it’s cancer?” She said she wasn’t sure but the biopsy would tell us. I said, “Listen, I like to be direct, and I like numbers. What’s the likelihood that this is cancer? 75%? 95%?” I reached for a high number so she wouldn’t sandbag me. When I said 95%, she tilted her head and looked thoughtful. She said, “Maybe 95%. 90-95%.”
I asked when I could schedule the biopsy. It was late on a Thursday afternoon. Impatient as always, I wasn’t happy when she said that I might have to wait until Monday. She must have seen a look of horror on my face because she said, “If you don’t mind waiting until I see my last patient, I can do it this afternoon.” I felt a rush of relief and agreed. “Meanwhile, I’ll have you meet with a nurse who will walk you through the biopsy procedure and have you sign a release.”
As I waited in the nurse’s cramped office, I called my sister, Deborah, on my cell phone. When she answered, I burst out crying.
“What’s wrong?” she said in her concerned, take-charge voice.
“I’m at the hospital. They think I might have breast cancer.” I filled her in on what had occurred. She asked if Alan was with me. I said, “No, I told him not to come. My gynecologist said it was nothing to worry about.” Then she asked if I had spoken to Alan. “No,” I said. “He’ll fall apart.”
“Stephanie, you have to tell him. He’s a grown-up. He’ll handle it.”
We also talked about whether I should wait until I had a diagnosis to tell my parents, who were spending the winter in California. We decided that I should call them right away, even though it might mean worrying them unnecessarily, because they could help me figure out what to do next.
Deborah told me she was sorry. “It’s okay, “I said. “I’m not worried about dying or anything. I just don’t want to go through whatever I’m going to have to go through in order to be okay.”
No one answered the phone at my parents’ house in California, and I was still afraid to call my husband. I called a family friend, Hank Goldberg, who is a physician, so I could ask him what to do next. He is our family’s go-to man when we have any kind of medical problem. His secretary answered and told me that he was unavailable. I said, “This is an emergency. How can I reach him?” She asked in a hushed, conspiratorial tone if someone had died. I said impatiently, “No one has died. I just need to talk to him right away.” She said she would contact him and ask him to call me.
One minute later, my cell phone rang. Hank said, “What’s wrong, baby?”
I burst out, “I think I have breast cancer!” He used his calmest voice, the one reserved for discussions with neurotic patients, and said in an almost patronizing tone, “What makes you think you have cancer?” I had a sudden realization that he probably thought I was at home in my bathroom looking at something scary on my breast.
I said with impatience, “because I’m at the hospital and the radiologist said so!” I could almost hear him snap to attention at the other end of the line.
The nurse came in at that point, and I told Hank I’d call him back. We discussed the biopsy procedure, and I signed the papers. The nurse spoke in a low voice, pausing after every few sentences to look at me. I didn’t understand why she was doing this. Was she trying to see if I understood what she was telling me? Or, was she waiting for me to cry?
I went back into the ultrasound room and lay down on the exam table. Because the biopsy was guided by ultrasound, the room was dimly lit. My chest was swabbed and draped, and the doctor gave me a local anesthetic. The nurse, the ultrasound technician, and the doctor worked quietly and efficiently, as I gripped the nurse’s hand for reassurance. The procedure was virtually painless. I was only unnerved by the loud snap of the probe as it nipped off bits of tissue. After the doctor finished obtaining samples, she explained that she was going to insert a tiny copper clip at the site of the biopsy. “This will help the doctors find the spot if it turns out that you do have cancer.”
I asked the doctor when I would get the results. She said that I might get them tomorrow afternoon, but I could have to wait until Monday. I thanked her for fitting me in at the end of her day, got dressed, and collected my things. As I was leaving the testing suite, I turned back. I walked into the waiting room to pick up one of those pamphlets about what to do when you’re diagnosed with breast cancer. I thought I might need one after all.
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